Clinical Implication of Meditation in Psychiatry : Focused on Mindfulness Meditation / 신경정신의학

There is a considerable body of literature describing the trials of meditation as adjunctive treatment of psychiatry. Although meditation has included various concepts and activity through a long history, meditation used as a therapeutic intervention in psychiatry has usually been accepted as a kind of emotion and attention regulation training. The aim of this article was to review historical origin, clinical effectiveness, and neurobiological mechanism of meditation as treatment for psychiatric disorders. Meditation is originated from various types of religious tradition. In general, meditation is divided by the consciousness meditation and the awareness meditation. Concept of mindfulness-based therapy is mainly based on awareness meditation. In addition to two types of meditation, loving kindness meditation is developed and exercised in compassion-focused therapy. Neurobiological evidence suggests that meditation reduces stress-related autonomic and endocrine change. In addition, research using neuroimaging has provided biological evidence that a specific region of brain activity and connectivity is related to subjective experience of meditation. Clinical trials support the effectiveness of meditation for the treatment of anxiety, depression, and any other stress-related disorders. In the future, profound understanding of the neurobiological mechanism, clinical effectiveness, and side effects of meditation as treatment intervention of for psychiatric disorders would be provided for evidence based meditative practice.

Incidence of Paresthesia during Needle-through-Needle versus Double-Segment Techniques for Combined Spinal-Epidural Anesthesia / 대한마취과학회지

BACKGROUND: Paresthesia is unpleasant for patients and more importantly, is related to neurological injury in some cases. There have been few studies comparing combined spinal-epidural anesthesia (CSE) techniques such as needle-through-needle technique (NTN) and double segment technique (DST) regarding the incidence of paresthesia. METHODS: Eighty-four parturients undergoing CSE for an elective cesarean section were divided into NTN and DST groups. A CSE was performed using 27 G Sprotte needle, 18 G Tuohy needle and 20 G multiport catheter in both groups. In the NTN group, at L3-4 or L4-5, a spinal anesthesia was performed and then an epidural catheter was inserted through the same Tuohy needle. In the DST group, an epidural catheter was inserted at L1-2 or L2-3 and then a spinal anesthesia was done two interspaces caudally. Incidences of paresthesia with each procedure were recorded with block characteristics and adverse effects. RESULTS: Overall frequency of paresthesia was higher in the NTN group (54.8% vs. 29.3%, P = 0.033). Incidences of intrathecal paresthesia were three times higher (21.4% vs. 7.3%, not significant) and epidural paresthesia was significantly higher (45.2% vs. 22%, P = 0.044) in the NTN group. Sensory and motor block characteristics and side effects were mostly comparable between the groups. CONCLUSIONS: Double-segment technique shows less incidence of overall paresthesia compared to needle-through-needle.